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Review of respiratory disease among Indigenous peoples

Introduction

Respiratory sickness is a major cause of illness among Indigenous people, with many people needing to be treated in hospital and quite a number dying from the sickness.

There are a number of different types of respiratory sickness that are usually grouped according to whether they affect the upper or lower parts of the breathing system (known as the upper and lower respiratory tracts) and whether they last only a short time - these are called ‘acute' sicknesses - or last a long time and/or come back often - these are called 'chronic' sicknesses. (For more information about these groupings and the various types of respiratory sicknesses, click here.)

The next sections look at respiratory sickness overall - how common it is among Indigenous people, then the sickness as a need for hospital treatment and as a cause of death.

The following sections then look separately at acute and chronic respiratory sicknesses, but also consider whether the sickness is mainly of the upper or lower respiratory tracts.

Frequency of respiratory sickness

Respiratory sickness was reported by 27% of Indigenous people who participated in the 2004-2005 National Aboriginal and Torres Strait Islander Health Survey [1]. It was reported more often by Indigenous people living in non-remote areas (30%) than by those living in remote areas (17%). These levels are slight lower from those reported to the 2001 National Health Survey.

After taking account of the age structures of the two populations, the overall levels of respiratory sickness were similar for Indigenous and non-Indigenous people [1].

Hospitalisation for respiratory sickness

Respiratory sickness was the cause of almost one-in-eight of the admissions to hospital of Indigenous people living in Queensland, WA, SA and the NT in 2004-05 (excluding those for renal dialysis) [2]. Admission to hospital for respiratory sickness was around three to four times more common for Indigenous people than for non-Indigenous people.

Acute respiratory illnesses (Influenza (flu) and pneumonia (infection of the lungs)) were the most common reasons why Indigenous males and females needed treatment in hospital. Needing treatment in hospital for these illnesses was almost five times more common for Indigenous men and almost six times more Indigenous women than for non-Indigenous men and women.

Deaths from respiratory sickness

Respiratory sickness is among the leading causes of death for Indigenous people, being the cause of around one-in-eleven of all deaths of Indigenous people living in Queensland, WA, SA and the NT in 2000-2004 [3]. Death from respiratory sickness was around four to five times more common for Indigenous people than for non-Indigenous people.

The most common type of respiratory sickness Indigenous people die from is chronic lower respiratory disease. Chronic lower respiratory sickness causes many more deaths than acute respiratory infections (pneumonia (infection of the lungs) and influenza (flu)).

Indigenous infants and very young children are much more likely to die from respiratory sickness than non-Indigenous infants and very young children. However, the biggest difference between Indigenous and non-Indigenous people in deaths from respiratory sickness is among people aged 25 to 54 years.

Acute respiratory infections (ARIs)

Frequency

There is very little information about the overall frequency of acute respiratory infections in the Indigenous population, but it is known that many Indigenous children will need to visit a clinic due to ARIs in their first year of life [4].

Hospital treatment for ARI

The need to be treated in hospital with an ARI is much more common for Indigenous people than for non-Indigenous people. For example, between 1988 and 1993, Indigenous infants in WA were more than six times more likely than non-Indigenous infants to need hospital treatment for acute bronchitis (infection of the main tubes that lead to the lungs) and bronchiolitis (infection of the tiny tubes in the lungs that lead from the bronchi) [5]. Pneumonia was the most common breathing sickness that put Indigenous children in hospital. For example, Indigenous infants were almost 28 times more likely than non-Indigenous infants go to hospital.

Pneumonia was the main respiratory sickness needing a hospital stay for Indigenous people in the age groups 15-24, 25-39 and 40-54 years. It was the second main cause of hospital stays in adults aged 55 years or older. In general, rates of going to hospital for pneumonia were higher in the country than in the city.

Deaths

The number of Indigenous deaths from ARIs has dropped over the last 20 years, but it is still an important cause of death. Death from an ARI is still several times more common for Indigenous people than non-Indigenous people. Among infants, death from an ARI was almost 16 times more common for Indigenous males than for non-Indigenous males, and around 19 times more common for Indigenous females than for non-Indigenous females [4].

Avoiding soil or muddy water during the wet-season in the tropics by using footwear and gloves [7].

Taking medicine as soon as possible when sick

Chronic respiratory sickness

Chronic respiratory sickness is more common for Indigenous people than for non-Indigenous people [1][8]. The main types of chronic respiratory sickness are asthma (reversible narrowing of the bronchi (the tubes connecting the throat to the lungs ) that causes coughing and wheezing), chronic bronchitis (infection of the tubes that lead from the throat to the lungs), emphysema (sickness of the air sacs in the lungs), and bronchiectasis (permanent, abnormal widening of the bronchi and bronchioles). (For more information about these types of sickness, click here.)

Asthma

Asthma is the most common breathing sickness reported by both Indigenous people (more than one-in-six) and non-Indigenous people (around one-in-eight) [1]. Asthma was reported more often by Indigenous people than by non-Indigenous people for every age group. Indigenous people living in remote areas reported having asthma slightly less often (less than one-in-six) than those living in the city and country (almost one-in-five). There may be more people in remote areas who have asthma than the survey shows. A more recent study of five communities in the Torres Strait and neighbouring areas of Cape York showed that more than one-fifth of 1,650 children aged 0-17 years had experienced wheezing (breathing with difficulty, producing a hoarse whistling sound), around one-in-eight had wheezed in the previous 12 months, and around one-in-six had asthma [9]. Somewhat higher levels of asthma were found among children aged 5 to 18 years in a 1999 study in a remote Indigenous community in the far north of WA: more than one-in-six males had asthma and almost one-in-eight females [10]. On the other hand, a study of a very small number of children living in a community in the central desert area of WA found that none of the 10 females studied had a history of asthma and only one of the 14 males did so [10].

Chronic bronchitis and emphysema

Little is known about the actual frequency of chronic bronchitis and emphysema in the overall Indigenous population, but these conditions are likely to be quite common because many Indigenous people smoke ( view HealthInfoNet tobacco use page ).

The most recent information about deaths from chronic lower respiratory sickness, mainly chronic bronchitis and emphysema, is for Indigenous people living in WA, SA and the NT in 1999-2001: deaths were around five times more common for Indigenous people than for non-Indigenous people [4]. In five areas in north Queensland, where Indigenous people make up three-quarters of the population, deaths for chronic obstructive pulmonary disease (COPD) (excluding asthma) were five times more common than for Queensland overall [11].

Bronchiectasis

Bronchiectasis (permanent, abnormal widening of the bronchi and bronchioles) and clinical chronic suppurative lung disease (CSLD) (lung sickness, where there is a lot of pus) are major problems for Indigenous children in Central Australia [12]. The average age of children with bronchiectasis was 4.8 years and 6.2 years for those with CSLD. Almost three-quarters of all the children had a history of chronic suppurative otitis media (CSOM) (repeated bacterial infection of the middle ear, with discharge and perforation of the ear drum).

Around two-fifths of the patients needed lung surgery for bronchiectasis. Over one-half of the cases had diarrhoea (needed to go to the toilet a lot) with dehydration (lack of fluid in their bodies). Sickness caused by a poor diet was common - two-thirds (67%) of the people with the sickness were underweight and shorter than average.

It is very important to find out if someone has bronchiectasis as soon as possible. Early detection can reduce death and serious lung damage [13]. It is very important for people with the disease to keep away from wood and tobacco smoke. Health workers with a special understanding of the sickness and of Indigenous culture are needed to deal with this illness.

References

Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics

Australian Institute of Health and Welfare (2006) Australian hospital statistics 2004-05. Canberra: Australian Institute of Health and Welfare

Australian Institute of Health and Welfare (2006) Australia's health 2006: the tenth biennial health report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare